Our Focus is Your Vision. Image Plus. Laser Eye Centre. LASER VISION CORRECTION Dr. James J. Wiens, M.D., FRCSC Medical Director

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1 Our Focus is Your Vision Image Plus Laser Eye Centre LASER VISION CORRECTION Dr. James J. Wiens, M.D., FRCSC Medical Director

2 Waking and seeing an alarm clock clearly, being able to see while swimming, and driving without corrective lenses - these are just a few examples of everyday pleasures that may be yours as a result of laser vision correction. Modern laser surgery techniques offered at IMAGE PLUS Laser Eye Centre may help you achieve a new way of viewing your world. see the world

3 LASIK For some, the doors to certain careers are opened. For others, it s the possibility of participating in recreational activities without depending on corrective lenses that brings them to IMAGE PLUS Laser Eye Centre. Whatever your reasons for considering laser vision correction, we want to help you make an informed decision that is right for you. Image Plus

4 Table of contents* 4 Laser vision correction - is it for you? 4 How will I know if it s right for me? 5 What is laser vision correction? 5 Are these techniques brand new? 6 Does IMAGE PLUS Laser Eye Centre have experience using these techniques? 6 Has laser vision correction been tested with clinical trials? 7 Am I a candidate for laser vision correction? 7 Why do I need glasses? 8 How do I read my prescription? 8 How refraction relates to acuity 9 How can I arrange for laser vision correction? 9 How do I prepare for my eye consultation and tests? LASER VISION CORRECTION 10 What is myopia, and how does laser vision correction treat it? 11 What is hyperopia, and how does laser vision correction treat it? 11 What is astigmatism, and how does laser vision correction treat it? WHAT ARE THE TYPES OF LASER VISION CORRECTION, AND HOW DO THEY DIFFER? 12 What is LASIK? 13 What is PRK? 14 Which of these two techniques is more common? 14 How do I know which one is best for me LASIK or PRK?

5 RISKS OF LASER VISION CORRECTION 15 Are there risks with laser vision correction? 15 What types of complications might there be with LASIK and PRK? 17 What complications occur mainly with PRK? 17 What complications occur mainly with LASIK? 19 What is presbyopia, and can laser vision correction help? 19 What is monovision? PROCEDURES 20 Should I have both eyes treated at once? 20 How do I prepare for my procedure? 21 When should I remove my contact lenses? 21 What will happen when I arrive at IMAGE PLUS for my procedure? 22 Do I need help getting home? 22 What happens after the procedure? 22 When will I see a difference in my vision? 23 When may I return to my usual activities? 23 What follow-up is needed? 24 DECISION-MAKING BC Location and contact information *Current as of Jan.1, 2000

6 Laser vision correction - is it for you? We can t promise 20/20 vision or life without glasses. Most patients with mild to moderate prescriptions, however, will achieve 20/20 vision or be within two lines of 20/20 on an eye chart. You may read your favourite novel without glasses. You may meet the vision requirements of most police and fire departments, or participate in recreational activities without glasses. It s all thanks to laser vision correction. How will I know if it s right for me? As with any surgery, you need to understand the benefits and the risks. We have developed this information guide as a resource to help you learn more about laser vision correction. Our team of trained staff and surgeons at IMAGE PLUS Laser Eye Centre are committed to providing quality care. We will help you find the resources you need to make an informed decision. This guide outlines what laser vision correction is, who qualifies as a candidate for laser surgery, and what the treatment process entails. We invite you to come and see us at IMAGE PLUS Laser Eye Centre and explore ways to change the way you see your world. 4

7 What is laser vision correction? Excimer laser technology has opened new possibilities for treating nearsightedness, farsightedness, and astigmatism. It has allowed the development of modern laser techniques that are collectively known as laser vision correction. These laser vision techniques reshape the surface of the eye (the cornea) using a cool beam of light. This beam of light gently removes microscopic amounts of tissue with each pulse, changing the shape of the cornea, allowing sharper focusing of images, and reducing your dependence on glasses and contact lenses. Are these techniques brand new? Laser vision correction was first done in 1987, with a technique called Photorefractive Keratectomy, known simply as PRK. This technique has received Canadian Health Protection Branch (HPB) and U.S. Food and Drug Administration (FDA) approval when used with a VISX excimer laser. PRK has received approval for nearsightedness (0 to 12 Diopters), astigmatism (0 to 4 Diopters) and farsightedness (+1 to +6 Diopters). More recently a second laser technique, Laser in Situ Keratomileusis, has become available. To date, Laser in Situ Keratomileusis (LASIK) has received approval from the FDA for the treatment of myopia and astigmatism. It is offered as an alternative to PRK. Modern Techniques 5

8 Does IMAGE PLUS Laser Eye Centre have experience using these techniques? IMAGE PLUS has been providing laser vision correction since LASIK is presently our most frequently performed procedure. Along with our medical director, Dr. James Wiens, a team of eye surgeons is available for you. These surgeons are trained in refractive surgery. Along with laser vision correction, their practices include treatment of various eye conditions, including those treated with laser surgery. In addition to laser vision correction, other refractive options offered include Intac rings, lensectomy Experience and cataract surgery. Has laser vision correction been tested with clinical trials? The benefits and risks of laser vision correction are recorded in the medical literature. We offer handouts for those who wish to see clinical trial results and percentages of effectiveness and safety. Note that the long-term effects of PRK and LASIK are not known. At IMAGE PLUS, we use the VISX Star Smooth Scan S4 IR (Iris Registration) excimer laser with VSS (Variable Spot Scanning). This laser provides our eye care team with the ability to treat nearsightedness (myopia), farsightedness (hyperopia) and astigmatism with both LASIK and PRK techniques. 6

9 Am I a candidate for laser vision correction? If you are over the age of 18, are free of eye disease, and have a relatively stable prescription for glasses or contact lenses, you may be a candidate for laser vision correction. Certain medical or eye conditions may prevent you from having laser vision correction. Examples include diabetes, using prednisone, pregnancy, or breast-feeding, poorly controlled autoimmune disorders such as rheumatoid arthritis or lupus. Please discuss your suitability with your eye doctor or the IMAGE PLUS staff, should one of the above or another medical condition pertain to you. Why do I need glasses? Refraction refers to the way light rays are focused by your eye. Clear vision depends on three things: the curvature of the cornea, the power of the lens, and the length of the eye. If these elements are not perfectly coordinated, refractive errors occur and corrective lenses are needed. These problems are in no way unusual or strange. They are known as myopia, hyperopia, and astigmatism. 7

10 How do I read my prescription? x 90 SPHERE AMOUNT OF NEARSIGHTEDNESS(-) OR FARSIGHTEDNESS(+) IN DIOPTERS CYLINDER AMOUNT OF ASTIGMATISM IN DIOPTERS AXIS ANGLE (LOCATION) OF THE ASTIGMATISM FROM 1 TO 180 DEGREES How Refraction relates to acuity* no refractive error low myopia moderate myopia high myopia REFRACTION ACUITY 0.0D= 20/ D= 20/30-1.0D= 20/50-1.5D= 20/80-2.0D= 20/ D= 20/ D= 20/ D= 20/ D= 20/ D= 20/ D= 20/ D= 20/ D= 20/ D= 20/800 *For example, the best a person with 20/500 vision can see from 20 feet is what a person with 20/20 vision can see from 500 feet. 8

11 How can I arrange for laser vision correction? The first step is to arrange for a thorough eye exam. This may be done with your eye doctor or arranged through IMAGE PLUS Laser Eye Centre. At this examination, your refraction will be determined, along with your best vision with corrective lenses. Your eyes will be examined to detect conditions that might require treatment prior to laser vision correction or that might make these procedures inappropriate for you. At your consultation, laser vision correction and other options will be discussed. Any questions you have will be answered. We require that several tests be done. One of these is corneal topography, a test that maps in detail the surface of your cornea. It reveals conditions that potentially may make surgery unsafe to do. The thickness of your cornea will also be measured to see if LASIK is an option. These two tests are done at IMAGE PLUS Laser Eye Centre. These tests, along with your eye examination, will determine whether or not you are a suitable candidate. How do I prepare for my eye consultation and tests? It is crucial that your eyes be in the most natural shape possible for your examination. Contact lenses change the curvature of your cornea. In order to receive accurate readings, contact lenses need to be removed for a period of time before your examination. Remove soft contact lenses two weeks prior to your consultation. Hard contacts must be taken out four weeks prior to your eye exam. Rigid contacts require Consultation a longer period of removal, up to eight to 12 weeks. 9

12 LASER VISION CORRECTION WHAT IS MYOPIA, and how does laser vision correction treat it? With myopia, near objects are seen more clearly than distant objects. It occurs when the eye is relatively too long, or when the corneal curvature is relatively too steep. As a result, the image falls in front of the retina, and is seen as a blurred image. To treat myopia, laser vision correction removes central corneal tissue. This decreases the curvature of the cornea and allows light rays to be focused further back in the eye, onto the retina. In myopia the image falls in front of the retina and is seen as a blurred image. 10

13 WHAT IS HYPEROPIA, and how does laser vision correction treat it? With hyperopia, near objects are initially seen as blurred. Eventually, distant objects will also become blurred. It occurs when the eye is relatively too short, or when the corneal curvature is too flat. As a result, the image is focused behind the eye and is blurred. Laser vision correction selectively removes peripheral corneal tissue, increasing the central corneal curvature. This allows the image to now be focused within the eye. In hyperopia the image is focused behind the eye and near objects are seen as blurred. Astigmatism occurs when the curve of the cornea is oval. WHAT IS ASTIGMATISM, and how does laser vision correction treat it? With astigmatism, both near and far vision is blurred. It occurs when the cornea is oval instead of round, and has more than one focal point. The light rays from these focal points form a blurred image on the retina, creating blurred vision for both near and distant objects. Laser vision correction removes specific areas of corneal tissue equalizing and rounding the curvature of the cornea. This forms one focal point instead of multiple ones. 11

14 WHAT ARE THE TYPES OF LASER VISION CORRECTION, AND HOW DO THEY DIFFER? TWO LASER VISION CORRECTION TECHNIQUES ARE PRESENTLY USED, WITH BOTH AVAILABLE AT IMAGE PLUS LASER EYE CENTRE. THESE ARE LASIK AND PRK. What is LASIK? Lasik is short for Laser in Situ Keratomileusis. LASIK procedures are performed on an outpatient basis and last about 15 minutes. The first step in LASIK is the creation of a flap of corneal tissue. This is done with a cutting instrument called a microkeratome, that cuts through about 30 percent of the cornea. This creates a flap of corneal tissue. This flap is gently lifted and folded over, exposing the inner corneal tissue. A series of cool, computer-controlled laser pulses then removes an appropriate amount of inner corneal tissue. Each pulse removes a microscopic layer. It does this without burning or cutting the cornea. The total laser time is usually no more than 60 seconds, typically removing ten to 15 percent of the cornea. Corneal flap is lifted. Laser shapes exposed surface of the cornea. Flap is repositioned Once completed, the flap is gently repositioned. The flap will securely adhere within two to three minutes. After confirming proper positioning of the flap, a clear plastic shield is placed over your eye to prevent injury. You should return home and rest for several hours. 12

15 What is PRK? PRK stands for Photorefractive Keratectomy. PRK is an outpatient procedure lasting about 15 minutes. It begins with the gentle removal of the outer protective layer of the cornea (the epithelium). The excimer laser then removes the appropriate amount of corneal tissue with a series of cool, computer-controlled laser pulses. Each pulse removes a microscopic amount of tissue without cutting or burning. After your PRK treatment is completed, a contact lens is placed on the cornea to promote healing, and several types of drops are given. You should return home and rest for several hours. The contact lens is needed until the epithelium heals. The recovery period typically lasts three to four days. Eye discomfort and irritation may be present until the contact lens is removed. While the contact lens is in place, you will need to use several types of drops. These usually minimize any discomfort you may experience. In myopia the surgeon selectively removes central corneal tissue to flatten the cornea. In hyperopia the surgeon selectively removes peripheral corneal tissue to steepen the central cornea. 13

16 Which of these two techniques is more common? At IMAGE PLUS Laser Eye Centre, we more commonly perform LASIK than PRK. While both LASIK and PRK procedures can treat nearsightedness, farsightedness and astigmatism, LASIK does have these additional advantages:» Faster visual recovery» Less discomfort after surgery» Less risk of infection» Reduced use of drops after treatment» Less risk of haze» Fewer visits needed after treatment How do I know which one is best for me LASIK or PRK? Your eye care physician and the staff at IMAGE PLUS Laser Eye Centre will guide you through this decision process. Your consultation visit and reading of this literature will help you know more about the differences. You can then make an informed decision based on your personal vision needs, your corrective lens prescription, and the benefits and risks of each procedure. 14

17 RISKS OF LASER VISION CORRECTION Are there risks with laser vision correction? The possibilities of a vision-reducing complication exist with any eye procedure. Some risks are common to both PRK and LASIK while others are specific to each. Some of the more common known risks are outlined below. These should be thoroughly discussed with your eye doctor and surgeon. The key to satisfaction is having realistic expectations. Laser vision correction is best seen as a procedure that decreases your dependence on glasses or contacts. You may still need corrective lenses for specific activities such as night driving or reading. What types of complications might there be with LASIK and PRK? Over-correction and under-correction - The healing that happens after your procedure is just as important as the procedure itself in determining your final result. Several factors affect how you heal. These include your initial prescription, the condition of your eyes, and your individual healing pattern. More correction is needed with a stronger initial prescription, requiring more healing. This increases the likelihood that one treatment will not be enough. If a second treatment is necessary, it is normally done no less than one to four months after LASIK, and no less than six months after PRK. LASIK patients requiring another treatment do not usually need another flap made. 15

18 16 Total If you are over-corrected after laser vision correction for nearsightedness, you may need reading glasses earlier than expected. Patients with lower levels of nearsightedness are able to remove their glasses for close tasks. After laser vision correction, this advantage is lost. Infection - The possibility of infection is rare for both PRK and LASIK. Infection, if it does occur, can lead to permanent damage of the cornea. Keeping your follow-up appointments and using your eye drops as directed are important to minimize this possibility. The chances for infection are one in 5,000 with LASIK and one in 1,000 with PRK. Night glare - Some patients have always had haloes or night glare. This may worsen or begin immediately after laser vision correction, and last for several months. For many patients, it will resolve with time. A small percentage, however, will experience night glare permanently. Patients with higher prescriptions and larger pupils develop this more frequently. Loss of best-corrected vision - A small percentage of patients will lose some sharpness to their vision. The bottom lines of the vision chart that you were able to read with your glasses or contacts before laser vision correction may not be readable afterwards. This is more common immediately after the procedure. For most patients, this problem will Care improve over the following months.

19 What complications occur mainly with PRK? Corneal haze - Haze is commonly seen in the first few weeks to months after PRK. It usually clears within several months. Haze does not often bother the patient. It is significant in approximately one percent of patients, occurring more frequently when higher prescriptions are treated. When necessary, haze can usually be removed with another excimer laser treatment. What complications occur mainly with LASIK? Difficulty creating the flap - This problem occurs in one to two percent of cases. The characteristics of some eyes may make it more difficult to create a flap. This may result in too short a flap, an irregular flap, or too thin a flap. Should these occur, the flap must be repositioned, and the procedure stopped. The cornea is allowed to heal for several months. The procedure may be redone no earlier than three months later. Usually the flap will heal smoothly causing no loss of vision. If irregular healing occurs, a loss of best-corrected vision may result. 17

20 Epithelial ingrowth - The epithelium is the thin layer of tissue that covers the outer surface of the cornea. Occasionally, the epithelium may grow between the flap and the inner corneal tissue. This occurs one to two percent of the time. It does not usually require treatment since it is usually self-limited. If the epithelium continues to grow, gently lifting the flap and removing the epithelium is needed. Flap displacement - This occurs in one percent of cases, usually within 24 hours of treatment. It happens less commonly in the next few weeks, usually following an injury to the eye. If the displacement is significant, the flap will require repositioning. Interface inflammation - This inflammation has been described as "Sands of the Sahara." Why it occurs has not been fully determined. If significant inflammation does happen (incidence of one percent), steroid drops are used. Steroid drops usually resolve the inflammation. 18

21 What is presbyopia, and can laser vision correction help? Presbyopia is a condition that typically begins when we reach our mid-40 s. The lens of our eye loses its natural ability to focus on close objects as we age. With time, the lens continues to harden, making it more difficult to see objects within an arms length. It is usually corrected with reading glasses or bifocals. Presbyopia cannot be corrected with a laser procedure. If you require reading glasses prior to laser vision correction, you will need them afterwards. If you do not yet need them, you may require them in the future. What is monovision? This term describes a laser technique where one eye is treated for distance and the other for near. This technique may delay or decrease your need for reading glasses, but not necessarily eliminate it. If you presently have monovision with your contact lenses, you may wish to discuss this option with your eye doctor. Some patients adapt easily to monovision while others struggle. For more information, discuss monovision with your eye doctor and surgeon. Inform 19

22 PROCEDURES ONCE YOUR CONSULTATION AND TESTS ARE DONE, AND YOU HAVE MADE A DECISION IN FAVOUR OF LASIK OR PRK, WE WILL SCHEDULE YOUR PROCEDURE. Should I have both eyes treated at once? Treating one eye at a time is always safer, since complications may arise. Many patients, however, prefer to have both eyes treated on the same day for a variety of reasons. The option of treating both eyes at once is chosen to improve balance between your two eyes, to possibly require less time off work, and for convenience. Most people prefer to have both eyes treated on the same day, or within several weeks of each other. This decision should be discussed with your eye doctor and surgeon. How do I prepare for my procedure? On your treatment day, you should wear comfortable, fiber-free clothing such as denim or cotton. Avoid using makeup, lotions, perfumes, hair sprays, or wearing earrings. Prepared 20

23 When should I remove my contact lenses? Contact lenses change the curvature of your cornea. In order to receive accurate treatment, you must do the following unless otherwise instructed by your surgeon:» Remove soft contacts two weeks before your procedure.» Remove hard contacts four weeks before your procedure.» Remove long-term rigid contacts eight to twelve weeks before your procedure. What will happen when I arrive at IMAGE PLUS for my procedure? You can expect to be at IMAGE PLUS Laser Eye Centre for approximately two hours. During this time, you will have time to review and sign the consent form, and ask any further questions. Prior to entering the laser suite, your eyelids and lashes are cleansed. Topical anaesthetic and antibiotic drops will be used. A mild sedative to help you relax during your procedure may be offered. In the laser suite, you will be positioned in a comfortable surgical chair. LASIK patients have their eye carefully draped to provide a clean working area. This is not necessary for PRK procedures. The information from your eye exam is entered into the computer software controlling the excimer laser. Your treatment is then done. Our trained IMAGE PLUS staff will stay with you throughout your procedure. They will assist the surgeon with your treatment. Afterwards, they will escort you to a patient lounge where you will be settled comfortably until you are ready to go home. 21

24 Do I need help getting home? Please arrange to have someone drive you home after your procedure. What happens after the procedure? You should return home and take a nap for several hours. LASIK patients initially experience some eye irritation and scratchiness. Usually this irritation is much improved after your nap, although a sensation of dryness may last for several days or weeks. Be prepared to take several days off work. PRK patients will need a contact lens until the epithelium heals, typically three to four days. Eye discomfort and irritation may be present until the contact lens is removed. For both LASIK and PRK patients, lubricating drops and pain medication will be provided in your Care Kit, should they be required. When will I see a difference in my vision? A dramatic improvement of vision is usually experienced within the first few days. The speed of recovery for both LASIK and PRK, however, does depend on your initial prescription and individual healing pattern. 22

25 When may I return to my usual activities? Please follow your doctor s instructions regarding normal activities. The following are some general guidelines:» Wait two weeks before taking a shower.» Avoid water activities such as swimming pools, spas, and hot tubs for one month.» Avoid contact sports for one month.» Avoid irritants like dust and smoke for two weeks (e.g., no gardening).» Avoid makeup or rubbing your eyes for two weeks.» Resume driving as recommended by your eye doctor. What follow-up is needed? Using your medications properly and keeping your follow-up visits are just as important as your surgery. It is important to ensure that your eyes heal as expected, without complication. Your eye doctor will assess your progress at these visits, keeping your surgeon informed. Those choosing LASIK will need regular follow-up visits at one day, one week, and at one, three, six, and 12 months. They usually need to use eye drops for about one week. Those choosing PRK will need more frequent follow-up visits. They will need daily visits until the contact lens is removed, monthly visits for the first six months, with a final follow-up at 12 months. They may need to use eye drops for a number of months. Follow-up 23

26 DECISION-MAKING Be informed - Read brochures, ask questions, see your eye doctor, and visit us at IMAGE PLUS Laser Eye Centre. Gather the information that you need to make an informed decision about laser vision correction. Determine your vision needs - Look at your lifestyle; look ahead. Be realistic and clear about your expectations of laser vision correction. Assess your eye health - Have a thorough eye examination done by your eye doctor. Know your refractive prescription. Book a consultation at IMAGE PLUS Laser Eye Centre. Weigh the risks and benefits - Compare the different procedures and assess your personal situation. Discuss these with your eye care doctor and surgeon. Plan for the procedure - Book a procedure date. Make the necessary arrangements for your home and work life. THE IMAGE PLUS TEAM OF SURGEONS WILL WORK WITH YOUR EYE DOCTOR TO PROVIDE COMPREHENSIVE CARE BEFORE, DURING, AND AFTER LASER VISION CORRECTION. 24

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28 At IMAGE PLUS Laser Eye Centre, we look forward to helping you change the way you see your world! Portage Place P One Canada Centre PORTAGE AVENUE The Bay KENNEDY STREET EDMONTON STREET P P CARLTON STREET GRAHAM AVENUE P P P Royal Winnipeg Ballet P P P P ST. MARY AVENUE MEMORIAL BLVD VAUGHAN STREET Centra Gas P KENNEDY STREET P EDMONTON STREET P Convention Centre CARLTON STREET YORK AVENUE Image Plus Laser Eye Centre Suite 1015, Medical Arts Building 233 Kennedy Street Winnipeg, Manitoba R3C 3J5 Phone: Toll Free: Web Site: For Further information, visit these web sites: Image Plus Laser Eye Centre

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